In 2011 the Centers for Medicare and Medicaid Services began offering incentives to providers who demonstrated “meaningful use” of electronic health records (EHRs). With this program well underway, how well is health information technology implementation progressing? What are the differences in adoption rates among health care providers?
To address aspects of health information technology adoption among US health care providers and organizations, Health Affairs is today releasing three Web First studies, which will also appear in the journal’s May edition. The studies will be discussed at a briefing tomorrow (Wednesday April 25) at the National Press Club in Washington D.C.
“Physicians In Nonprimary Care And Small Practices And Those Age 55 And Older Lag In Adopting Electronic Health Record Systems,” by Sandra Decker of the Centers for Disease Control and Prevention’s National Center for Health Statistics and coauthors. To analyze the rate of adoption of EHR systems from 2002 to 2011 among office-based physicians, the authors used data from the annual National Ambulatory Medical Care Survey. Overall, there was a 38 percentage point increase in EHR adoption among office-based physicians, and by 2011 more than half of physicians had EHR systems, tripling the percentage of physicians with EHRs over the decade. Adjusting for other characteristics, physicians in small (1–2 physicians) practices were less likely to have made the change (25.9 percentage point increase in adoption rate versus a 54.6 percentage point increase during the decade for practices with 10 or more physicians). Age and specialty were also factors. Primary care physicians increased their adoption by 8.6 percentage points more than non–primary care physicians over the decade. Physicians aged 55 and older increased adoption by 20.4 percentage points less than physicians aged 45 years or younger. “To achieve…nationwide adoption, federal policies may…have to focus on encouraging adoption among non–primary care specialists, as well as addressing persistent gaps in the use of electronic records systems by practice size, physician age, and ownership status,” the authors write.
“Small, Nonteaching, And Rural Hospitals Continue To Be Slow In Adopting Electronic Health Record Systems,” by Catherine DesRoches of Mathematica Policy Research and coauthors.In the first nationally representative survey of hospital EHR system adoption since the federal incentive program began, the authors examined the rate of EHR adoption among US hospitals, using data from the American Hospital Association annual survey of health information technology. Overall, they found that the percentage of hospitals with at least a basic EHR system increased from 15.1 percent in 2010 to 26.6 percent in 2011. Also, they found that 18.4 percent of US hospitals had achieved what is a reasonable proxy for meaningful use, a large jump from just 4.1 percent in 2010.
The authors identified a widening gap in adoption of EHR systems based on hospital size, teaching status, location, and region. For example, although there was a 15 percentage point gap in EHR adoption between small and large hospitals in 2010, that gap had widened to nearly 22 percentage points in 2011. “We believe that federal policy makers need to redouble their efforts among hospitals that appear to be moving slowly,” conclude the authors. “It will [also] be critically important for policy makers now finalizing the stage 2 criteria to take into account that more than 80 percent of hospitals could not meet stage 1 criteria in 2011.”
“Most Physicians Were Eligible For Federal Incentives In 2011, But Few Had EHR Systems That Met Meaningful-Use Criteria,” by Chun-Ju Hsiao of the Centers for Disease Control and Prevention’s National Center for Health Statistics and coauthors. This study is one of the first to look at physicians’ eligibility and intentions to apply for federal incentives as well as capabilities of physicians’ EHRs to support meaningful use. The authors used data from the 2011 Electronic Medical Records Supplement to the National Ambulatory Medical Care Survey, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics and sponsored by the Office of the National Coordinator for Health Information Technology.
In all, 91 percent of physicians were eligible for Medicare or Medicaid incentives because they received Medicare revenue or had approximately the required Medicaid volume. About 51 percent of physicians intended to apply for meaningful-use incentives; however, only 11 percent reported having EHRs with at least 10 of the 15 capabilities required to support stage 1 core meaningful-use objectives. Among those intending to apply for incentives, practices with 11 physicians or more were 14.3 percentage points more likely to demonstrate stage 1 meaningful use than those in solo or two-physician practices. Physicians in practices not owned by physicians were also more likely to be ready for meaningful use. Non–primary care physicians and physicians eligible for Medicaid incentives were less likely to be ready. “The 2011 survey results portray widespread gaps in readiness across the states,” conclude the authors. “The low level of current readiness illustrates the challenges in meeting the federal schedule for financial incentives.”